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Anti Psych

Psych medications for Pharmocology

Common CONVENTIONAL Antipsychotic medication Chlorpromazine (Thorazine)(Low potency)Fluphenazine (Prolixin)(High potency)Haloperidol (Haldol)(High potency)
Decanoates Long acting injectable medications that take 5-7 days to start working. Available in Fluphenazine (Prolixin) and Haloperidol (Haldol)
Akathesia motor restlessness; intolerance of inactivity; cannot stay still; jittery
Extra Pyramidal Symptoms (EPS) Akathesia; Acute dystonia; Parkinsonism
Acute dystonia Muscle spasm, feeling of thick tongue& stiff neck; eyes roll back, arched back, repetitive movements, increased muscular tone. Usually in males.
Parkinsonism a neurological disorder in which a few but not all of the symptoms of Parkinson disease are present.
Symptoms of Coventional Meds EPS, Tardive dyskinesia, Neuroleptic Maliganant Syndrome (NMS). Anticholinergic, lower seizure threshhold, dysrhythmias, blood dyscrasias, sexual, dysfunction, increase prolactin levels, sun sensitivity-> (lifetime)
Chlorpromzine (thorazine) Conventional med, Low potency. very sedating, lowers seizure threshold, NMS, orthostatic hypotension, photosensitivity
Thioridazine (Mellaril) Conventional med, Low potency. QT prolongation; cardiac side effects
Haloperidol (Haldol) EPS early in treatment (Parkinsonism), weight gain
Atypical Antipsychotic Meds Advantages *Produce far fewer EPS (if any)*May effectively treat people unresponsive to conventional antipsychotics*Minimally elevate prolactin levels*Significantly reduce negative symptoms
Atypical Antipsychotic Meds Disadvantages *Weight gain*Insulin resistance- DMII can develop*Cost*Other side effects: rare EPS, parkinsonism, sedation, seizure
Clozaril (Atypical) Side Effects **Agranulocytosis- drop in white blood cell count*Glucose intolerance*Weight gain*Drooling*Sedation*Orthostatic hypotension*Seizures at high doses(for +/- symptoms, works on DOP4 not DOP2 involuntary movement is not a problem)
Clozaril Side Effects continued **BLACK BOX WARNING (risk of severe/life threatening side effects)1) agranulocytosis2) Myocardidtus3) Syncope- orthostatic hypotension
Respiridone (Atypical) Adv: Different preparations- PO or injection, Consta, "M"= melt in your mouthDisadv: increase prolactin level, EPS (mostly akathesia)
Olanzapine (Zyprexa) Atypical *Weight gain*Diabetes*Approved for use with bi-polar disorder*Zydis ("M")
Quetiapine (Seroquel)Atypical *Hypotension*Dizziness*Sedation*Weight gain*Cataracts*Grapefruit juice no not take
Ziprasidone (Geodon) Atypical *Lower incidence of weight gain*Lower risk of developing diabetes*Must be given with meals*IM available*May be effective in improving cognitive functioning*Start at 40 mg. BID. Starting lower increases incidence of side effects
Aripiprazole (Abilify) Atypical *Dopamine system stabilizer*Aproved for Bi Polar disorder*Fewer side effects*With all the atypical antipsycotics, there is still a small risk of EPS and NMS
Paliperidone (Invega) Atypical *Metabolite (remake) of Risperdal*New to the market*Invega does not elevate Prolactin level and does not cause akathesia
Atypical Drug Interactions Oversedation w/ other cns depressants; alcohol cause + sensitivity to side effectsTegretol & Prilosec change rate in metabolismIncreased incidence of orthostatic hypotension with sedatives, antihypertensives, alcoholAvoid abrupt withdrawal
Atypical Nursing Interventions *Medication teaching*Assess willingess to comply with medication regime*Educate about weight management, proper nutrition*Educate about the S/S of diabetes
Antidepressants Treatment: Cognitive behavioral and other therapies Meds (TCA’s, SSRI’s MAOI’s, new meds, herbal) Generally used for 6-12 months after symptoms resolve. ECT, Self-care (diet, exercise, relaxation)Also used for panic disorder (1-2 mon. to fully work)
Tricyclic Antidepressants (TCA’s) *Nortriptyline (Pamelor)*Imipramine (Tofranil)*Amitryptyline (Elavil)*Clomipramine (Anafranil)*Desipramine (Norpramin)
TCA side effects Orthostatic hypotensionAnti-cholinergic: *Urinary retention*Weight gainCardiotoxicity (especially with OD)Lowers seizure threshholdSome low risk of NMS (Neuroleptic Malignant Syndrome)
SSRI's (Selective Seratonin Reuptake Inhibitors) Treatment of depression and all types of anxiety disorders*Fluoxetine (Prozac)*Sertraline (Zoloft)*Paroxetine (Paxil)*Citalopram (Celexa)*Fluvoxamine (Luvox)
SSRI's Advantages Advantages: Faster to achieve therapeutic effects (1-3 weeks), not anti-cholinergic, less sedation, no orthostatic hypotension, relatively safe with overdose
SSRI's Disadvantages/ side effects: High incidence of GI upset, sexual dysfunction, weight gain, withdrawal syndrome, costSerotonin syndrome- life threatening. Can happen at beginning. lack of coordination, fever, tremor, hallucination, startling, death.
Monoamine Oxidase Inhibitors (MAOI’s) Marplan, Nardil, ParnateFor ppl not responsive to other agentsSide effects: sedation, anti-cholinergic, toxicity, hyperstensive crisisMust wait 2 weeks after discontinuing an SSRI or TCA to start MAOI’s!
Foods to Avoid with MAOI's Hypertensive crisis with foods that contain tyramine can be life threatening: Chinese food, soy sauce, aged cheese, wine, beer, liver, bananas, avocados, chocolate, yeast extract, meat tenderizers
Considerations in medication selection *Prior positive response*Response of family member*Side effects*Interactions with other medications*Patient preference*Patient age*Cost/insurance*Concurrent medical disorders
Mood stabilizers: Lithium Excreated by Kidneys: Low sodium, increased lithium; Dehydration, increased lithium. short half life, Narrow therapeutic window 0.8-1.4 mEq/L. Levels drwan in am b4 morning dose
Lithium side effects *Nausea, diarrhea*Fatigue, muscle weakness*Headache, confusion*Polyuria, increased thirst (flushed out med)*Mild hand tremor*Renal toxicity*Hypothyroidism and goiter* Can be cardiotoxic
Lithium Toxicity ***Vomiting, diarrhea, hyperactivity of muscles, ataxia, seizures, dysrhythmias, gate changes, EKG changes, confusion. Death can result from pulmonary complicationsCause of toxicity: diarrhea, dehydration, over dose
Mood stabilizers: Valproic Acid 1st line choiceDepakote, Depakene*Advantages: works faster than Lithium, fewer side effects*Target plasma leves 50-125 mg/ ml*Adverse reactions: thrombocytopenia, pancreatitis, liver failureNO ALCOHOL
Other anticonvulsants used as mood stabilizers Carbamazine (Tegretol, Carbitrol)-many drug to drug interactions. Blood dysgracia, bone marrow suppressionLamotrigine (Lamictal)- look 4 rash: Steven Johnson Syndrom- promote weight loss, treat migraineGabapentin (Neurontin)Topiramate (Topamax)
Anxiolytics Decreases anxietyDiazepam (Valium)Lorazepam (Ativan)Alprazolam (Xanax)Clonazepam (Klonopin)Chlordiazepoxide (Librium)
Benzodiazepines 1st line 4 anxiety; r meant 4 short term All about the same, differ in onset & duration of actionDiazepam= muscle spasmLorazepam= elders Relatively safe in overdose situationFlumazenil, given IV, can be used with ODGood for sleep problemst. rx
Benzodiazepine side effects Hypotentsion Drowsiness Anterograde amnesia Paradoxical effects- agitated instead of relaxDependence/abuseAvoid alcohol/caffeine bc they stimulate CNS instead of suppress.Sudden stop= seizure/agitationCombining other opioids may cause death
Busperone (Buspar)(Not CNS depressant) Advantages: lower abuse potential, no sedation, does not potentiate other cns depressantsDisadvantages: effects develop slowly, cannot be used as prnGenerally well-tolerated. Erythromycin and grapefruit juice will potentiate actions
Barbiturates High abuse/ dependence potentialVery seldom used except; Anti-seizure, Severe insomnia, induction of anesthesiaOverdose picture: respiratory depression, coma, PINPOINT PUPILS, hypotension, hypothermiatreatment for OD is treating symptoms
Sleep Aids Not for long term; interrups REM Sleep*Zolpidem (Ambien)*Zoleplon (Sonata)*Lunesta*Ramelteon (Rozeram)
CNS Stimulants MOA: paradoxical methodIndicated for ADHD/ ADD and narcolepsyMethylphenidate (Ritalin)Amphetamine/dextroamphetamine: Adderall
CNS Stimulants side effects Side effects: cns stimulation, restlessness, insomnia, dysrythmias, hypertension, appetite suppression, in excessive amounts- psychosisAbuse potential
CNS Preparations Short Duration: Ritalin, Adderall Intermediate duration: Ritalin SR,Long duration: Ritalin LA, Adderall XR, Concerta
Provigil: CNS stimulant used for narcolepsy Side effects: Headache, nausea, diarrheaDoes not disrupt night time sleepUsual dose 200 mg. in a.m.Schedule IV
Created by: MissNana



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